International Journal of Pharmacy and Pharmaceutical Sciences

ISSN- 0975-1491 Vol 8, Issue 3, 2016

Original Article
A PROSPECTIVE INTERVENTIONAL STUDY OF KNOWLEDGE, ATTITUDE AND PRACTICE
(KAP) TOWARDS TUBERCULOSIS AMONG PATIENTS WITH KOCH’S DISEASE

SARANYA P.1, SWATHI S.1, KOUSALYA K.1, PRAVEEN D.1

Dept. of Pharmacy Practice, School of Pharmaceutical Sciences, Vels University, Velannagar, PV Vaithyalingam road, Pallavaram, Chennai
600117, Tamil Nadu, India
Email: saro08bpharm@gmail.com
Received: 21 Aug 2015 Revised and Accepted: 13 Jan 2016
ABSTRACT
Objective: To evaluate the knowledge, attitude and practice (KAP) of tuberculosis patients and to provide structured patient education through
patient counselling on disease, drugs and lifestyle modifications in tuberculosis patients.
Methods: All enrolled patient received structured & standard education regarding the disease tuberculosis, medication, diet & lifestyle modification
after the preliminary assessment of KAP towards TB. Changes in the knowledge, attitude, and practice in the post-intervention phase were assessed
and analyzed statistically.
Results: Change in knowledge score of the patients before and after counselling was observed as 37.74% to 79.06% where the mean change in
percentage is 41.32%. The change in the attitude of the patients before and after counselling was found to be 21.61%. Counseling towards practice
before and after counseling was increased from 63.18% to 82.12% with a mean change of 18.94%.
Conclusion: Change in KAP due to educating the patients would help in the increased adherence to antitubercular therapy (ATT) in the patients
with tuberculosis; thereby resistance towards the drugs can be reduced.
Keywords: Tuberculosis, Koch’s disease, Compliance, KAP study.

INTRODUCTION understand the patients’ knowledge, attitude and practice towards

Tuberculosis (TB), a globally widespread, and in many cases
fatal, infectious disease caused by various strains of mycobacterium,
usually Mycobacterium tuberculosis [1]. Tuberculosis is classified as
one of the granulomatous inflammatory diseases. Macrophages, T
lymphocytes, B lymphocytes, and fibroblasts aggregate to form
granulomas, with lymphocytes surrounding the infected
macrophages. Effective TB therapy is hindered by restricted drug
entry into the mycobacterial cell wall that possesses an unusual
structure and chemical composition and thereby makes many
antibiotics ineffective [2]. The risk of reactivation increases with
immune-suppression, such as that caused by infection with Human
Immunodeficiency Virus (HIV). In people co-infected with M.
tuberculosis and HIV, the risk of reactivation increases to 10% per
year. Studies using DNA fingerprinting of M. tuberculosis strains
have shown reinfection contributes more substantially to recurrent TB
than previously thought, with estimates that it might account for more
than 50% of reactivated cases in areas where TB is common [3].
the antitubercular medication therapy, disease nature, etc. This
could help in identifying the lacunae in education for patients
towards TB and how pharmacist-provided optimized counselling
helps in medication adherence and thereby therapeutic success.
MATERIALS AND METHODS
Study population
The sample size was calculated with a margin of error of 5%, a
confidence level of 95% and a level of distribution of 50 % amongst
an average population of 200 (based on a primary survey at the
hospital). The calculations showed a recommended sample size to be
132 individuals. The study proposal was approved by the
Institutional Ethics Committee (IEC/DOPI/2015/03). It was carried
out for a period of six months in the chest & TB outpatient
department of a tertiary care hospital.
Selection and withdrawal of subjects

Subramanian Tet al. did a study on Knowledge and Misconception of
Pulmonary Tuberculosis at Dots Centre, Urban Meerut and found
that poor knowledge and misconception concerning TB was quite
concern in the patients. He mentioned that unless the TB patients
are educated related to causation of TB, mode of spread and
methods of prevention, tuberculosis control program will be less
effective [4]. Mukhtar A. Solliman et al. assessed the Knowledge
towards Tuberculosis among General Population in North East Libya
and reported that knowledge towards TB within the population was
poor. The author also recommends structured educational programs
to be developed for community members to promote awareness
towards TB [5].
The main aim of this study was to assess the impact of patient
counselling on the knowledge, attitude and practice towards
tuberculosis in patients with Koch’s disease. The key objective was
to evaluate the knowledge, attitude and practice of tuberculosis
patients and to provide structured patient education through patient
counselling on disease, drugs and lifestyle modifications for
tuberculosis patients. This is a study that was carried out to
Those patients who received antitubercular therapy and had the
willingness to answer the survey questionnaire were invited for
participation in the study. Childbearing women, children (age<18 y),
mentally incompetent patients, deaf and dumb patients and patients
under last month of their treatment were excluded from the study.
Study instrument
The questionnaire was validated to check for its accuracy with the
help of a pilot study (sample size of 10 patients). Test and retest
method was done with a Cron Bach alpha score of 0.8. Patient
demographics, educational background, and social habits, socio-
economic conditions, past medical history, past medication history
were collected using structured data entry form designed for this
study. All the study participants were assessed for their
understanding, thoughts& practice towards anti-tubercular therapy
using suitable questionnaire. All enrolled patient received structured
& standard education regarding the disease tuberculosis,
medication, diet & lifestyle modification. Changes in the knowledge,
attitude and practice in these patients after the Pharmacist’s
intervention were assessed statistically [6].
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Int J Pharm Pharm Sci, Vol 8, Issue 3, 58-61

The questionnaire included questions to assess the patient’s Statistical analysis

knowledge on the disease, its cause, epidemiology, transmission,
symptoms, complications, treatment options, etc.
The questions to assess attitude included patient’s attitude towards
prevention, curability, thoughts on risk factors such as tobacco
smoking, social isolation, vaccination, etc [7]. The questions to assess
Practice included patient’s practice of personal cleanliness, time and
routes of administration, diet patterns, follow up etc.
Statistical analysis was done using prism-graphpadv6.0. Student t
test was done using SPSS statistics and observed the mean changes
between the changes in KAP before and after patient education and
calculated with p<0.05.
RESULTS
The following results were obtained from this study.

Table 1: Gender distribution

Gender No. of patients N=132 % of patients
Male 81 61%
Female 51 39%
Total 132 100%
Out of 132 tuberculosis patients included in the study 81(61%) were male and 51(39%) were female.

Table 2: Age distribution

Age No. of patients N=132 % of patients
18-20 8 6%
21-30 22 16%
31-40 26 20%
41-50 20 15%
51-60 29 22%
61-70 16 12%
>70 11 8%
The mean age of the study population was 45±16 y. Among the 132 patients, most of them 26(20%)-20(22%) were in the age ranging between 31-
40 and 51-60 respectively.

Table 3: Social habits distribution

Social habits No. of patients % of patients
Smoking 74 56%
Alcohol 63 48%
Total 117 89%
It was found that 89% of the patients were smokers, and 48% were alcoholics.

Table 4: Comorbidity distribution

Comorbidity No. of patients N=132 % of patients
DM 29 22%
SHT 6 5%
DM,SHT 17 13%
TOTAL 52 39%
Around 52(39%) patients had a comorbid condition in which 29(22%) had diabetes, 6(5%) were hypertensive and 17(13%) were both diabetic as
well as hypertensive.

Table 5: Tuberculosis classification distribution

TB classification No. of patients N=132 % of patients
Pulmonary tuberculosis 116 88%
Extra-pulmonary tuberculosis 16 12%
Around 116(88%) were affected with pulmonary tuberculosis, followed by 16(12%) with extra-pulmonary tuberculosis patients among the 132 patients.

Table 6: Mean KAP score pre and post intervention

Study parameter Pre-intervention Post intervention Change in
Percentage
Knowledge 4.15(±0.70) 8.90(±0.70) 41.32%
Attitude 8.41(±1.41) 11.7(±0.70) 21.61%
Practice 6.31(±2.12) 8.21(±1.41) 18.94%
Changes in KAP scoring between PRE and POST intervention is shown. Accordingly the mean of knowledge was 4.15±0.70 & 8.90±0.70, mean of
attitude was found to be 8.41±1.41 & 11.70±0.70 and the mean of practice was observed as 6.31±2.12 & 8.21±1.41 before and after counselling
respectively.

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Int J Pharm Pharm Sci, Vol 8, Issue 3, 58-61

Table 7: Kap score amongnst patient before and after counselling

KAP Before After
Poor Good Poor Good
N=132 % N=132 N=132 % N=132 %
Knowledge 118 89.39 14 10.60 0 0 132 100
Attitude 50 37.87 82 62.12 0 0 132 100
Practice 44 33.33 88 66.67 0 0 132 100
Before counselling the number of patients whose score was poor in knowledge, attitude and practice were 118, 50 and 44 and who scored good
were 14,82 and 88 respectively. No poor score in knowledge, attitude and practice were found after counselling

Table 8: Changes in good score of kap after intervention

Study parameter BI good score % BI scores AI good scores % AI scores
Knowledge 14 10.60 132 100
Attitude 82 62.12 132 100
Practice 88 66.67 132 100
Good score of knowledge, attitude and practice changed from 10.60%, 62.12% and 66.67% to 100% in TB patients post-intervention.

Table 9: Knowledge, attitude and practice of patients before and after counselling.
KAP Before counselling(BC) After counseling(AC) Mean
Knowledge 37.74% 79.06% 41.32%
Attitude 56.11% 77.72% 21.61%
Practice 63.18% 82.12% 18.94%.
Change in knowledge score of the patients before and after counselling was observed as 37.74% to 79.06% where the mean change in percentage is
41.32%. The change in the attitude of the patients before and after counselling was found from 56.11% to 77.72% with mean change of 21.61%
respectively. Counseling towards practice before and after counseling was increased from 63.18% to 82.12% with mean change of 18.94%.

Table 10: Changes in average kap score before counselling and after counselling
KAP Score BC AC
18.89 28.81
The average KAP score of the study population in the pre and post intervention phase was found to increase from 18.89% to 28.8%.

DISCUSSION knowledge, attitude and practice towards tuberculosis due to

Among the 132 patients, male (61%) were found to be more, which
is similar to that reported by Haasnoot PJet al. [8]. Marinac JCet al.
mentioned that patients between 21-40 y of age are highly affected
with TB, which is in contrast to the present study results, where
20%& 22% of the patients were between 31-40 y &51-60 y of age
correspondingly[9]. In the present study, 56% of the participants
were smokers and 48% were alcoholics. About 29 (22%) TB patients
had diabetes as comorbidity, 6(5%) had hypertension, and 17 (13%)
had both diabetes and hypertension. Amid the study population,
about 116(88%) patients suffered from pulmonary tuberculosis and
16 (12%) by extrapulmonary tuberculosis, which is similar to that
reported by Singh M M et al. [10].
In the current study only 10.60%, 62.12% and 66.67% has a good
score of knowledge, attitude and practice in the pre-interventional
phase whereas 100% good score of KAP after counselling which is
similar to the results of Granje et al.[11]. The average KAP score
before counselling was 18.89 and the average KAP score after
counselling was 28.81. There seemed to be a significant change in
the patient knowledge, attitude and practice towards tuberculosis
over time after counselling, which is also accepted for the study
reported by Purohit SD et al.[12].
A paired t test was done to analyse the difference in KAP before and
after counselling which showed a significant difference (p<0.0001)
between these 2 scores. This confirms that knowledge, attitude and
practice improve after structured patient counselling.
CONCLUSION
In the current study, knowledge, attitude and practice of patients
have been improved after patient counselling. Change in the
structured education by the pharmacist would help in increasing
medication adherence of the antitubercular drugs; thereby
resistance towards the drugs can be minimized. This will further
help in preventing the disease transmission as well.
CONFLICT OF INTERESTS
Declare none
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